Yersinia pseudotuberculosis Infection Complicated with Bacteremia in a 10-Month-Old Boy

Yersinia pseudotuberculosis (Y. pseudotuberculosis) infection complicated with bacteremia rarely occurs. Y. pseudotuberculosis infection is also known to produce various symptoms similar to Kawasaki disease (KD) due to the production of Y. pseudotuberculosis-derived mitogen (YPM), an exotoxin with superantigen activity. Moreover, it causes terminal ileitis and is responsible for appendix swelling. Here, we report a case of Y. pseudotuberculosis infection in a 10-month-old boy who was brought to our hospital due to fever, watery stool, and poor vitality. Abdominal echocardiography revealed wall thickening of the entire colon and appendix swelling; therefore, he was admitted and treated with antibiotics for bacterial enteritis or appendicitis. After the antibiotic administration, facial skin rashes and hand and foot edema developed. However, he had 5/6 major symptoms of KD and was diagnosed with Y. pseudotuberculosis infection because of its presence in the blood and stool cultures. Thereafter, antibacterial therapy improved his symptoms and increased the inflammatory response. After his hospital discharge, the skin on his fingers showed desquamation like that of KD. Y. pseudotuberculosis infection should be considered as a differential disease in KD, terminal ileitis, and appendicitis. Furthermore, its infection route and culture methods should also be carefully considered.

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Diversity of Cardiac and Gastrointestinal Presentations of Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19: A Case Series

Global Pediatric Health ◽

10.1177/2333794x21996613 ◽

2021 ◽

Vol 8 ◽

pp. 2333794X2199661

Author(s):

Anuja R. Shikhare ◽

Rimsha M. Iqbal ◽

Rabail Tariq ◽

Daniel R. Turner ◽

Bassam M. Gebara ◽

...

Keyword(s):

Kawasaki Disease ◽

Gastrointestinal Symptoms ◽

Case Series ◽

Asymptomatic Infection ◽

Cardiac Monitoring ◽

Delayed Presentation ◽

Terminal Ileitis ◽

Serologic Evidence ◽

Cardiac Manifestations ◽

Inflammatory Syndrome

COVID-19 is generally a benign or asymptomatic infection in children, but can occasionally be severe or fatal. Delayed presentation of COVID-19 with hyperinflammation and multi-organ involvement was recently recognized, designated the Multisystem Inflammatory Syndrome in Children (MIS-C). Six children with MIS-C with molecular and serologic evidence of SARS-CoV-2 infection were admitted to our hospital between May 5, 2020 and June 25, 2020. All had fever and weakness; 4/6 presented with gastrointestinal symptoms. Two children had features of complete Kawasaki disease, 3 had incomplete Kawasaki disease, while 1 had terminal ileitis with delayed onset of circulatory shock. Treatment consisted of intravenous immunoglobulin and aspirin for Kawasaki-like disease. Remdesivir, corticosteroids, and infliximab were used when indicated. Median hospitalization was 7 days. Immediate treatment resulted in rapid clinical improvement. In children presenting with hyperinflammatory syndromes without cardiac manifestations, testing for SARS-CoV-2 RNA and antibodies, with close cardiac monitoring should be pursued due to the manifold presentations of SARS-CoV-2 infection in children.

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A case of acute terminal ileitis caused by yersinia pseudotuberculosis.

Nihon Naika Gakkai Zasshi ◽

10.2169/naika.75.650 ◽

1986 ◽

Vol 75 (5) ◽

pp. 650-653

Author(s):

Hiroyuki KOSHIYAMA ◽

Kazuo SUWA ◽

Yasunori UEDA ◽

Isao DOI ◽

Shohei KUSAKA

Keyword(s):

Yersinia Pseudotuberculosis ◽

Terminal Ileitis

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Epiploic Appendagitis: An Often Misdiagnosed Cause of Acute Abdomen

Case Reports in Gastroenterology ◽

10.1159/000502683 ◽

2019 ◽

Vol 13 (3) ◽

pp. 364-368

Author(s):

Vishnu Charan Suresh Kumar ◽

Kishore Kumar Mani ◽

Hisham Alwakkaa ◽

James Shina

Keyword(s):

Abdominal Pain ◽

Bowel Wall ◽

Acute Diverticulitis ◽

Lower Abdominal Pain ◽

Wall Thickening ◽

Antibiotic Administration ◽

Epiploic Appendagitis ◽

High Attenuation ◽

History Of ◽

Bowel Wall Thickening

Epiploic appendages are peritoneal structures that arise from the outer serosal surface of the bowel wall towards the peritoneal pouch. They are filled with adipose tissue and contain a vascular stalk. Epiploic appendagitis is a rare cause of acute lower abdominal pain. It most commonly results from torsion and inflammation of the epiploic appendages, and its clinical features mimic acute diverticulitis or acute appendicitis resulting in being often misdiagnosed as diverticulitis or appendicitis. This frequently leads to unnecessary hospitalization, antibiotic administration, and unwarranted surgeries. Epiploic appendagitis is usually diagnosed with CT imaging, and the classic CT findings include: (i) fat-density ovoid lesion (hyperattenuating ring sign), (ii) mild bowel wall thickening, and (iii) a central high-attenuation focus within the fatty lesion (central dot sign). It is treated conservatively, and symptoms typically resolve in a few days. Therefore, epiploic appendagitis should be considered as one of the differential diagnosis for acute lower abdominal pain and prompt diagnosis of epiploic appendagitis can avoid unnecessary hospitalization and surgical intervention. In this case report, we discuss a 72-year-old woman who presented with a 2-day history of acute left lower abdominal pain.

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Analysis of Kawasaki disease showing elevated antibody titres of Yersinia pseudotuberculosis

Acta Paediatrica ◽

10.1080/08035250600750080 ◽

2006 ◽

Vol 95 (12) ◽

pp. 1661-1664 ◽

Cited By ~ 17

Author(s):

Masahiro Tahara ◽

Kiyoshi Baba ◽

Kenji Waki ◽

Yoshio Arakaki

Keyword(s):

Kawasaki Disease ◽

Yersinia Pseudotuberculosis ◽

Antibody Titres

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Late Wall Thickening and Calcification in Patients After Kawasaki Disease

The Journal of Pediatrics ◽

10.1016/j.jpeds.2016.10.026 ◽

2017 ◽

Vol 181 ◽

pp. 167-171.e2 ◽

Cited By ~ 8

Author(s):

Nobuyuki Tsujii ◽

Etsuko Tsuda ◽

Suzu Kanzaki ◽

Jun Ishizuka ◽

Koichiro Nakashima ◽

...

Keyword(s):

Kawasaki Disease ◽

Wall Thickening

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Subpopulations of Stressed Yersinia pseudotuberculosis Preferentially Survive Doxycycline Treatment within Host Tissues

mBio ◽

10.1128/mbio.00901-20 ◽

2020 ◽

Vol 11 (4) ◽

Cited By ~ 1

Author(s):

Jasmine Ramirez Raneses ◽

Alysha L. Ellison ◽

Bessie Liu ◽

Kimberly M. Davis

Keyword(s):

Bacterial Growth ◽

Intraperitoneal Injection ◽

Bacterial Infections ◽

Yersinia Pseudotuberculosis ◽

Antibiotic Administration ◽

Bacterial Cells ◽

Fluorescent Reporter ◽

Content Type ◽

Drug Concentrations ◽

Host Tissues

ABSTRACT Severe systemic bacterial infections result in colonization of deep tissues, which can be very difficult to eliminate with antibiotics. It remains unclear if this is because antibiotics are not reaching inhibitory concentrations within tissues, if subsets of bacteria are less susceptible to antibiotics, or if both contribute to limited treatment efficacy. To detect exposure to doxycycline (Dox) present in deep tissues following treatment, we generated a fluorescent transcriptional reporter derived from the tet operon to specifically detect intracellular tetracycline exposure at the single bacterial cell level. Dox exposure was detected in the spleen 2 h after intraperitoneal injection, and by 4 h postinjection, this treatment resulted in a significant decrease in viable Yersinia pseudotuberculosis bacteria in the spleen. Nitric oxide-stressed bacteria preferentially survived treatment, suggesting that stress was sufficient to alter Dox susceptibility. Many bacteria (∼10%) survived a single dose of Dox, and the antibiotic accumulated at the periphery of microcolonies to growth inhibitory concentrations until 48 h posttreatment. After this time point, antibiotic concentrations decreased and bacterial growth resumed. Dox-treated mice eventually succumbed to the infection, albeit with significantly prolonged survival relative to that of untreated mice. These results indicate that Dox delivery by intraperitoneal injection results in rapid diffusion of inhibitory concentrations of antibiotic into the spleen, but stressed cells preferentially survive drug treatment, and bacterial growth resumes once drug concentrations decrease. This fluorescent reporter strategy for antibiotic detection could easily be modified to detect the concentration of additional antimicrobial compounds within host tissues following drug administration. IMPORTANCE Bacterial infections are very difficult to treat when bacteria spread into the bloodstream and begin to replicate within deep tissues, such as the spleen. Subsets of bacteria can survive antibiotic treatment, but it remains unclear if this survival is because of limited drug diffusion into tissues, or if there are changes within the bacteria, promoting survival of some bacterial cells. Here, we have developed a fluorescent reporter to detect doxycycline (Dox) diffusion into host tissues, and we show that Dox impacts the bacterial population within hours of administration and inhibits bacterial growth for 48 h. However, bacterial growth resumes when antibiotic concentrations decrease. Subsets of bacteria, stressed by the host response to infection, survive Dox treatment at a higher rate. These results provide critical information about the dynamics that occur within deep tissues following antibiotic administration and suggest that subsets of bacteria are predisposed to survive inhibitory concentrations of antibiotic before exposure.

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